The Wheezing Bear

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![The health of the Russian people is astonishingly low. (Maxim Marmur/The Associated Press)](/content/uploads/4.jpg)The health of the Russian people is astonishingly low. (Maxim Marmur/The Associated Press)
When Goldman Sachs included Russia in its now-infamous delineation of the “BRIC” countries—Brazil, Russia, India, and China— as key emerging markets in 2002, businessmen around the world scrambled to cash in on the former superpower’s coming economic boom. Since then, soaring oil prices have led Russia to meet and exceed even the loftiest of the investment bank’s expectations. Since the election of Vladimir V. Putin in 2000, Russia has successfully reasserted itself as a major world power, emerging from the economic and social unrest of the 1990s stronger and more confident than it has ever been. Moscow now boasts the largest number of billionaires and the highest cost of living of any city in the world. And in the political realm, the Kremlin’s newfound confidence has been on prominent display throughout the year, starting in May with the now nearly-forgotten military parade in Red Square—the first since the fall of the Soviet Union—and continuing with the surprisingly aggressive invasion of Georgia three months afterward.

Yet behind the skyscrapers, imported luxury cars, and tough-guy image, a daunting list of problems leaves the future of the world’s largest nation in serious doubt. Chief among these is the country’s healthcare system, which ranks poorly against other industrialized nations. Yet the Russian Federation must also deal with abnormally high death rates compared to other European countries and the growing specters of AIDS and tuberculosis. Some researchers, such as Nicholas Eberstadt of the American Enterprise Institute, have suggested that simply returning to the level of health present in the country 30 years ago would be a major achievement.

In the modern era, where human capital is so highly valued, Russia’s 59-year male life expectancy (several years lower than that of Bangladesh, for comparison) reveals an almost total lack of sustainability for current economic growth. Compounding this handicap is the negative momentum of the healthcare system—the current life expectancy for Russian men is nearly four years lower than that recorded for the same group in 1961. No other industrialized country has ever recorded such a drop in life expectancy over such a prolonged period, especially in peacetime.

Healthcare in the Russian Federation, as a whole, falls far below Western standards in almost every area, from primary care to obstetrics. Doctors, whose qualifications can vary substantially throughout the country, are chronically hampered by inadequate facilities and insufficient funding. As a result, Russians face risks and encounter health problems that citizens of Western Europe and other industrialized nations rarely even consider.

Examples of these issues include (figures as of 2004) a syphilis incidence rate 100 times higher than that of Germany, infertility following 10 to 20 percent of all abortions (a procedure eight times more common than in the United States), and the fact that “only a third of Russian babies are born healthy and…some 50 to 60 percent of all Russian children suffer from a chronic illness,” according to Murray Feshbach of the Woodrow Wilson International Center for Scholars. Though the Russian government has attempted to remedy the problem by increasing spending on the health sector in recent years, expenditures as a percentage of GDP still lag far behind the countries of the European Union.

Russia’s low fertility rates are no lower than those of Western Europe, whose current demographic situation has led commentators and researchers to produce such titles as “The Last Days of Europe: Epitaph for an Old Continent” and “Decline and Fall: Europe’s Slow Motion Suicide.” It is, rather, Russia’s much higher death rate that sets it apart from its neighbors to the west. Nicholas Eberstadt reported in 2007 that “for every 100 babies being born in Russia today there are about 150 people dying.” A United Nations report released in May of this year produced an even more dire statistic: 17 deaths for every 10 births. As a result, Russia’s population may plummet from the current 140 million to below 100 million by 2050. The authors of the report felt that Russia’s death rate was so high that it warranted an entirely new term: “hypermortality.”

According to the UN report, “mortality in Russia is 3-5 times higher for men and twice as high for women” than in countries at a similar level of economic development. Even more devastating for the Russian economy is the fact that this phenomenon is found primarily in the working-age population. To put the situation in perspective, a 20-year-old man from Switzerland today has more than an 80 percent chance of surviving to age 65. A 20-year-old Russian man, on the other hand, has a less than 50 percent chance of reaching that age. Apart from the obvious result of constraining economic growth, this shrinkage of the workforce will also raise the country’s dependency ratio (the ratio of the economically dependent part of the population, i.e. young and old people, to those of working age) to a projected maximum of 1:1 by 2025.

Both the UN report and a separate report from the World Bank released in June of this year state that the major causes of this high mortality rate include limited access to healthcare services, excessive alcohol and tobacco consumption, poor diet, and a terrifying road safety record. Death rates in the country are so high, the UN report says, that they are reminiscent of a country affected by a major war.

“At the moment, there are no grounds to believe that the crisis will be overcome and the size of the population will be stabilized,” the UN report added.

Exacerbating the “hypermortality” situation in the Russian Federation are the twin scourges of AIDS and tuberculosis. “Without factoring the impact of AIDS,” the aforementioned UN report says, “the number of males age 15-24 could decline by nearly half over the next 20 years.” That number is startling enough (especially when its implications for the Russian military, for example, are considered), but including AIDS-related deaths would paint an even grimmer picture.

According to the UN report, the number of officially registered cases of HIV in the Russian Federation increased by a factor of 370 from 1997 to 2007. Most estimates place the country’s current HIV-positive population at roughly 1 million, though some estimates are as high as 1.4 million infected persons, or 1 percent of the population. Researchers are worried that Russia is about to reach a “tipping point” on the way to a full-blown epidemic of AIDS—it took only seven years for prevalence rates in South Africa to skyrocket from 1 percent to 20 percent. Equally surprising is the lack, until very recently, of serious effort by the government to fight the disease. As recently as 2004, the Russian health ministry employed only three people specializing in HIV/AIDS.

As for tuberculosis, the Russian newspaper “Gazeta” reported on September 18 that nearly a third of the regions of the Russian Federation have a rate of infection of tuberculosis of more than one person per 1000 in the population. This prevalence rate is nearly 20 times greater than that of the neighboring Scandinavian countries. In addition, an increasing number of these infections are multi-drug-resistant (meaning that first-line antibiotics have no effect), and some cases are even extensively drug-resistant, meaning that neither first- nor second-line antibiotics can destroy the infection. HIV/AIDS and tuberculosis are now so widespread in Russia that a senior member of the Duma recently singled them out as threats to the country’s national security.

If Russia cannot overcome the health problems described above, it risks entering a period of prolonged economic decline. The recent bubble in oil prices helped hide many of the country’s problems behind rising GDP numbers, but this situation is not sustainable in the long term. Confronting Russia’s problems will be costly and will take a tremendous amount of both effort and time. Failure to do so, however, could bring quite dire consequences. Russia’s ambitious neighbors are more than ready to snatch up its resource-rich Far East.